Care Health Insurance Company Limited

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About Care Health Insurance Company

Care Health Insurance Company (Formerly known as Religare Care Health Insurance Company Limited) is a part of Religare Group established in July 2012. It is a direct subsidiary company of Religare Enterprises Limited. Care Health is a leading player in the health insurance industry of India.

It is a specialised health insurance provider offering a suite of insurance solutions in the retail segment. Its plans include International Travel Insurance, Health Insurance, Personal Accident, Critical Illness and Top-up coverage along with Group Health Insurance for Corporates and Companies.

Key Highlights of Care Health Insurance Company

Claim Settlement Ratio 95.2% for F.Y 19-20
Claims Settled 25 lacs+ claims till March 2021
Networked Hospitals 16500+ Cashless healthcare providers 
Grievance Ratio 37 less grievance ratio per 10,000 claims. 

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Awards and Achievements of Care Health Insurance Company

Care Health Insurance has been bestowed with various awards and accolades ever since its inception. A few of its achievements are as follows:

  • The company was awarded as ‘The Best Health Insurance Company’ at ABP News-BFSI Awards in 2015.
  • Care Health Insurance was adjudged as ‘Best Claims Service Provider of the Year’ in 2018 at Insurance India Submit Awards.
  • Care Health Insurance also received ‘Editor’s Choice Awards for Best Product Innovation’ in 2013 at Finnoviti.

Key Features of Care Health Insurance Plans

Some of the coverage benefits that are found across most Care health insurance plans are as follows:

Coverage benefit  Meaning 
Hospitalisation cover Hospitalisation cover is designed to cover your medical expenses that are incurred on an inpatient basis, i.e. when you are hospitalised for 24 hours or more. The cover includes room rent, nurse’s fee, doctor’s fee, treatment costs, and the like
Pre hospitalisation cover If you incur medical expenses before you are hospitalised, such expenses can be claimed as pre hospitalisation expenses. These expenses are covered up to a specific number of days before hospitalisation 
Post hospitalisation cover If you incur medical costs after you are discharged from the hospital, such costs can be claimed under this benefit. Costs up to a specific number of days after hospitalisation are covered 
Daycare treatments Treatments that involve only a few hours of hospitalisation are called daycare treatments. Such treatments are also covered under Care health insurance plans 
Organ donor expenses If you are receiving an organ from a donor for undergoing an organ transplant surgery, the cost of the donor’s hospitalisation and organ harvesting would be covered 
AYUSH coverage  AYUSH stands for Ayurveda, Unani, Siddha and Homeopathy. These are non-allopathic treatments that are covered under many Care health insurance plans
Free health check-ups Care Health Insurance Company promotes healthy living for its customers. As such, its health plans allow free check-ups to monitor your health at regular intervals
Domiciliary treatments Domiciliary treatments are those which are taken at your own home. These treatments are covered if there are no hospital beds or if you cannot be moved to the hospital. 

Common exclusions in Care Health Insurance Plans

Care Health Insurance offers comprehensive health insurance plans. However, in some cases, the claim is not payable. Such cases fall under policy exclusions. Each policy has a list of exclusions which can be found in the policy wordings. However, some commonly found exclusions include the following –

  • Illnesses that you have when you are buying a Care health plan are called pre-existing illnesses or diseases. Such conditions have an associated waiting period with them. They are not covered during the specified waiting period
  • Specific treatments like cancer, piles, hernia, joint replacement surgeries, etc. have a specific waiting period which is, usually, 2 years
  • If you suffer from any illness or disease within the first 30 days of buying a Care health plan, coverage would not be available for them
  • Cosmetic or weight control treatments are excluded
  • Illnesses or injuries that occur due to war and allied perils or due to nuclear or chemical contamination are not covered
    Dental treatments are excluded
  • Substance abuse, alcoholism, criminal acts, etc. are not covered
  • Unscientific or experimental treatments are not covered

Health plans of Care Health Insurance Plans

Care Health Insurance offers a wide range of health insurance policies. Some of the best policies, available at PayBima, are as follows –

1. Care

Care is the company’s most popular health plan which offers a comprehensive scope of protection. The policy has many salient features which are as follows –

  • Inbuilt maternity coverage at higher sum insured levels

If you opt for sum insured levels of Rs.50 lakhs and above, you can get an inbuilt maternity coverage under the policy. The coverage would cover the expenses of pregnancy and childbirth.

  • Sum insured restoration 

If you use your sum insured on a claim and if there is an unrelated second claim, the policy restores the sum insured so that the second claim can be paid. This benefit helps in the case of multiple claims within the same policy year and ensures that you have sufficient coverage when needed

  • No restriction on entry age

There is no upper entry age. Individuals of all ages can buy the plan for their coverage needs.

  • Free second medical opinion

You can avail of a free second opinion from Care’s team of medical experts. Such a second opinion is available under all variants of the plan and allows you to consult another specialist, free of cost, in severe illnesses.

2. Care with NCB

Care with NCB is nothing but the aforementioned Care plan with the added coverage of Super No Claim Bonus. Let’s understand the salient features of this version of the plan –

  • Super No Claim Bonus

The plan has a unique super no claim bonus feature. Under this feature, if you don’t claim in one policy year, you get a no claim bonus of 50% of the base sum insured. Thereafter, if no claim is made in the second successive year, another 50% increase in the sum insured is allowed. This doubles the base sum insured within 2 years without any claim.

  • Added no claim bonus

Besides the super no claim bonus, you continue to earn a 10% increase in the sum insured as the no claim bonus if you don’t make a claim. This increase is allowed up to a maximum of 50% of the base sum insured.

  • Higher coverage, free of cost

When you combine the super no claim bonus and the no claim bonus features, you get a high sum insured. Together with the super no claim bonus, your sum insured becomes 220% after two successive claim-free years. This is free of cost and you don’t have to pay the premium for the increase in the sum insured.

  • International coverage 

Under plans that have a sum insured of Rs.50 lakhs and above, you can avail of international coverage through the Care Anywhere benefit. This allows wider coverage and is beneficial.

  • Range of add-ons

There are a variety of add-ons available with the policy which you can add by paying additional premiums to enhance the scope of coverage.

3. Care Freedom

The Care Freedom plan doubles up as a policy for individuals suffering from diabetes, hypertension or BMI issues. The salient features of the policy are as follows –

  • Different plan variants

There are two plan variants available under the policy. The first one is a basic health plan available for adults as well as children. The second variant, however, is available only to adults aged 46 years and above and is designed to cover their health needs.

  • Automatic sum insured recharge

If you suffer a big claim and the sum insured is used up, the plan restores the sum insured back to its original amount so that if you suffer another claim, the plan would be able to cover it too.

  • Consumable allowance cover

Hospitalisation results in various non-medical costs too that are not covered under the health insurance policy. As such, the plan allows you a daily allowance for each day of hospitalisation so that you can meet such non-medical expenses

  • Coverage for dialysis

Every time you visit a hospital for getting dialysis, the medical costs incurred would be covered under the policy. Coverage is allowed up to Rs.1000/sitting for a maximum of 24 consecutive months.

  • Companion benefit

If your hospitalisation exceeds 10 days, the plan offers a lump sum companion benefit to help you meet the additional costs that you might have incurred due to such prolonged hospitalisation.

4. Care Enhance

A super top-up health insurance policy, Care Enhance allows you to enhance your existing health insurance coverage without burning your pockets. The salient features of the policy are as follows –

  • Wide range of sum insured and deductible options

The plan offers a wide range of coverage and deductible options so that you can choose the amount that you want and which matches your needs. You can, thus, customise the plan as per your coverage needs.

  • International coverage

Under the second plan variant coverage for international treatments is allowed if taken in an emergency. So, you can expand the geographical scope of coverage with the policy and avail of treatments anywhere.

  • Add-on coverage for expert opinion

The policy offers an add-on benefit wherein you can avail of an expert’s medical opinion if required. This coverage is available at an additional premium.

Schedule of benefits of Care Health Insurance Plans

Features  Care  Care with NCB Care Freedom Care Enhance
Inpatient hospitalisation Covered  Covered  Covered  Covered 
Pre and post hospitalisation  30 and 60 days respectively  30 and 60 days respectively  Up to 7.5% or 10% of the sum insured 30 and 60 days respectively 
Daycare procedures  Covered  Covered  Covered  Covered 
AYUSH cover Available  Available  Not available Not available 
Donor expenses Covered

Up to Rs.50,000 to Rs.3 lakhs

Covered

Up to Rs.50,000 to Rs.3 lakhs

Not available  Covered 

Up to the sum insured 

Sum insured recharge Available

Up to 100% of the base sum insured 

Available

Up to 100% of the base sum insured 

Available

Up to 100% of the base sum insured 

Not available 
Domiciliary hospitalisation Covered

Up to 10% of the sum insured 

Covered

Up to 10% of the sum insured 

Covered

Up to 10% of the sum insured 

Not available 
Ambulance cover Covered

Up to Rs.1500 to Rs.3000

Covered

Up to Rs.1500 to Rs.3000

Covered

Up to Rs.1000

Not available 
Daily allowance Only for sum insured up to Rs.4 lakhs at Rs.500/day Only for sum insured up to Rs.4 lakhs at Rs.500/day Available

Rs.750 to Rs.1000 per day

Not available 
Health check-ups Annually Annually Annually  Annually 
Second opinion Available Available Available  Available 

As an add-on 

No Claim Bonus 10% of the sum insured up to a maximum of 50% 10% of the sum insured up to a maximum of 50% Not available  Not available 
Super No Claim Bonus Not available Available

50% increase after each claim-free year up to a maximum of 100%

Not available  Not available 
Care Anywhere Available if the sum insured is Rs.50 lakhs and above Available if the sum insured is Rs.50 lakhs and above Not available  Yes

Under the second variant only

Maternity cover Available if the sum insured is Rs.50 lakhs and above Available if the sum insured is Rs.50 lakhs and above Not available  Not available
Entry age Minimum – 5 years onwards

Dependent children – 3 months onwards on a floater basis

Minimum – 5 years onwards

Dependent children – 3 months onwards on a floater basis

Adults – 18 years or 46 years depending on plan variant

Children – 90 days onwards

Adults – 18 years onwards 

Children – individual basis – 5 years to 24 years

Floater basis – 1 day to 24 years

Sum insured  Rs.3 lakhs, Rs.4 lakhs, Rs.5 lakhs, Rs.7 lakhs, Rs.10 lakhs, Rs.15 lakhs, Rs.20 lakhs, Rs.25 lakhs, Rs.30 lakhs, Rs.40 lakhs, Rs.50 lakhs, Rs.60 lakhs or Rs.75 lakhs Rs.3 lakhs, Rs.4 lakhs, Rs.5 lakhs, Rs.7 lakhs, Rs.10 lakhs, Rs.15 lakhs, Rs.20 lakhs, Rs.25 lakhs, Rs.30 lakhs, Rs.40 lakhs, Rs.50 lakhs, Rs.60 lakhs or Rs.75 lakhs Rs.3 lakhs, Rs.5 lakhs, Rs.7 lakhs or Rs.10 lakhs Rs.1 lakh to Rs.10 lakhs, Rs.15 lakhs and Rs.20 lakhs
Deductible – Rs.1 lakh to Rs.30 lakhs, Rs.35 lakhs, Rs.40 lakhs, Rs.45 lakhs, Rs.50 lakhs, Rs.55 lakhs
Term of the plan 1, 2 or 3 years
Premium payment frequency In one lump sum

Annually

Half-yearly

Quarterly

Monthly

Pre-existing waiting period 4 years 4 years 2 years 4 years

How to buy Care Health Insurance Plans?

Care Health Insurance plans are available offline as well as online. You can buy Care Health Plan online by following a smooth process through PayBima.com. The process to buy Care Health Plan through PayBima is as follows:

  • Select the plan online

Begin the process by visiting PayBima’s official website or just click on www.paybima.com and click on ‘Health Insurance.’

  • Fill in the details

Fill in all the required details to enable PayBima to calculate the premium based on your eligibility and coverage requirements. Details such as your name, age, lifestyle habits, gender, location, sum insured and the number of dependents are required to be provided. Also, provide your contact details to get personalised consultation on phone to guide you to buy the best health insurance at a reasonable price.

  • Compare available plans

A list of available plans will be displayed after the submission of your details. Care Health Insurance plans would also be on the list. You can select the best plan after comparing the available plans.

  • Fill and submit the proposal form

After finalising the policy, provide your details in the proposal form. Fill the form correctly and submit it online.

  • Pay premium online

The policy is issued instantly after online payment of premium, in case there are no adverse declarations about medical history and lifestyle habits in the proposal form.

  • Medical Screening

You might be required to undergo medical screening before issuance of the plan based on your age, lifestyle habits, gender, coverage and pre-existing illness. You can avail of the check-up facility at any of the networked hospitals of the insurance company.

How to renew Care Health Insurance Policy?

Besides buying, you can also renew your health insurance plan through PayBima. Simply click on www.paybima.com to visit the website and renew your plan. To enjoy uninterrupted coverage and lifelong renewals renew the policy within the due date.

You can renew your Care Health Insurance plan by providing your policy number and other policy details. You can also check all the plan details at the time of renewal and make changes to your policy if required. The policy will be renewed within minutes after the online payment of the premium. You can contact PayBima at 1800 267 67 67 for renewing your plan or send a mail at PayBima care@mahindra.com.

How to file a claim of Care Health Insurance Policy?

Care Health Insurance provides two options to claim on your health insurance policy. The first is the reimbursement mode in which you have to initially pay the hospital bills and then get them reimbursed. The second is cashless claim settlement wherein the company will directly pay the bills on your behalf.

The following steps should be taken for a cashless claim in your Care Health Insurance plan:

1. Admission to a network hospital

For a cashless claim settlement, get admitted to a hospital with which the insurance company has a tie-up. You will first have to locate your nearest network hospital. You can locate the nearest network hospital by visiting the official website of the insurance company or by calling the customer helpline. Show your ID proof and health card to the hospital and get admitted.

2. Pre-authorisation claim form

A pre-authorisation claim form is to be submitted for cashless claim approval. The form is needed at least 48 hours before planned hospitalisation. In case of emergency admission, you can submit the form within 24 hours. The form can be taken from the TPA desk of the hospital or can also be downloaded online and submitted to the insurance company.

3. Approvals

The claims management team of Care health insurance will send an approval letter to the network hospital based on the pre-authorisation claim form. Once the approval letter is received cashless treatment would be allowed.

4. Reimbursement Claim

If you get admitted to a non-networked hospital or if your cashless claim is rejected by the claim management team, then your claim will be handled on a reimbursement basis. You will have to submit the claim form along with relevant documents. Once approved, all the bills will be reimbursed by the insurer.

You can seek the help of PayBima’s executives for easy settlement of your health insurance plan. Just call at 1800 267 67 67 or mail at paybima.care@mahindra.com and we will guide you with your claim process and its settlement.

Documents required for successful claim settlement of Care Health Insurance Plans are as follows:

  1. Claim form, duly filled and signed
  2. Doctor’s prescription
  3. ID proof of Insured
  4. Health Card
  5. Pre-authorisation form
  6. Bank account details for reimbursement claims
  7. Original medical bills and receipts
  8. Hospital reports, consultation notes and prescriptions for reimbursement claims.

Review of Care Health Insurance Plans

Care Health Insurance plans are quite comprehensive and are well-customised as per individual requirements. Other highlights include the following:

  • The company has been consistently working in the effective application of innovation and technology to deliver excellent customer service and customer satisfaction.
  • Care Health Insurance deliver wide-ranging health insurance policies that are customised to meet the diverse healthcare requirements of its customers.
  • Care Health Insurance received the ‘Best Health Insurance Product Award’ various times at FICCI Healthcare Excellence Awards.
  • The company firmly believes in trust, technology, transparency and customer-centric service.
  • It has the highest claim settlement ratio making it a trusted health insurance provider to rely on.
  • The company ensures to provide cashless claim approval within 2 hours through its in-house claim team

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Frequently Asked Questions

Q: Do Care health insurance plans allow any discount?

Yes, a range of premium discounts is available under Care health insurance plans. Each plan has its own set of discounts but the commonly available discounts include the following –

  • Discount for a long-term policy
  • Discount for covering more family members on an individual basis
  • Group discount
  • Discount for buying the policy online, etc.

Q: What is the maximum age for buying Care health insurance policies?

Under most Care health insurance plans, there is no maximum entry age. Care’s plans allow entry to individuals of all ages.

Q: Is there any grace period for paying the outstanding premium?

Yes, a grace period of up to 30 days is allowed under most Care health insurance plans.

Q: What are pre-existing illnesses?

When you are buying a new health insurance policy, you might have some medical conditions like diabetes, high BP, asthma, etc. These medical conditions, that already exist at the time of a new policy purchase, are called pre-existing illnesses.

Q: What is the limit for availing of free health check-ups?

There is no limit for annual health check-ups. Depending on your plan and coverage limit, a pre-defined set of medical check-ups can be availed at the networked diagnostic centres.

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Gayatri Prabhu, Head-Digital Business at Mahindra Insurance Brokers Limited (MIBL) is one those few digital leaders who has the width and depth that is required to execute an ROI driven holistic digital strategy. She cuts through the noise, identifies the critical levers and leads her team to successful execution of the defined strategy. Her core mantra to win new and retain existing customers is: understand the consumer behavior and craft experiences around it.

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